The pain of infertility can be especially hard on people of faith because some religious traditions object to a number of medical procedures used to overcome it.
For Catholics, whose church raises the widest array of concerns, it can be especially daunting, said Eileen Kummant, a family practice physician in White Oak who helps Catholics treat infertility without violating church teaching.
Even the most faithful, who often seek her practice because of her values, are tempted to ignore moral concerns when their own efforts to conceive have failed, she said.
"A lot of people are really hurting when they have infertility problems. Sometimes they just don't want to think about anything that might say they can't do whatever is necessary to have a baby -- especially when it seems that other people have no problem with it," she said.
"It seems like a hope that they are told they can't have."
She will be one of the presenters Saturday at an infertility workshop sponsored by the Catholic Diocese of Pittsburgh. It will address spiritual, moral, relational and medical aspects of infertility.
A variety of religious traditions have qualms or outright bans on certain aspects of infertility treatment, though some of the science is so new that it is still being debated. The Catholic Church, Orthodox churches and most evangelical Protestants object to procedures in which embryos are destroyed, as is often the case with "extra embryos" from IVF. Some Orthodox Jewish groups share Catholic church objections to masturbation to collect semen.
The most widespread qualms concern the use of surrogate mothers. Conservative Christians and Muslims regard it as adultery. Some liberal Protestant traditions have raised questions about the exploitation of women who hire out their wombs. The Catholic Church stands virtually alone in its objection to any procreative act that doesn't involve sex between a husband and wife -- but treatments have been developed that take that concern into account.
At Saturday's workshop, church teaching will be explained, but so will medical solutions that the church accepts, said Susan Rauscher, head of the diocesan Social Awareness Office.
One example is lower tubal ovum transfer, where a blocked egg is moved from the upper to the lower part of the fallopian tube and fertilized there. Catholic ethicists are divided over whether it's permissible to artificially inseminate a wife with her husband's sperm, she said. Although conservative theologians once rejected the practice, some now say it can be done if the semen is collected during intercourse using a condom with a tiny hole that makes it open to the possibility of conception.
The workshop will address the stress that some infertility treatments can place on a couple. That is a concern shared by the Rev. Ronald Cole-Turner, a United Church of Christ minister who teaches ethics at Pittsburgh Theological Seminary. Dr. Turner, who isn't part of the workshop, doesn't object to the destruction of early embryos but raises other issues.
"I think there is a growing concern among Protestants who have defended this technology. It's not that we reject it, but we want to encourage couples, and women in particular, to be fully aware of what they are getting into," he said.
Infertility treatments can turn what is supposed to be the most intimate act into a cold, invasive medical procedure.
"I sometimes joke that if men had to go through it, there wouldn't be much interest in reproductive technology," he said.
"It's true that infertility can work against a marriage. But infertility treatment can also take its toll on a marriage. With honest communication and prayerful engagement, many couples find themselves seriously considering adoption or a life without children but devoted to the service of others."
He trains future clergy to help couples think through their desire for a child of their own. It can be due to pressure from relatives or male pride, he said.
People of faith should ask themselves whether, in a world filled with need, expensive infertility procedures are the best use of their money, he said.
"That longing for children is recognized as legitimate in the Bible. It is a deeply felt longing, but it is one that can be socially manipulated so that a woman might feel she is somehow inadequate. So we need to challenge that. It's one thing to long for a child. It's another thing to allow that to drive us to pay any cost."
Dr. Kummant's concern for infertility began when she was a medical missionary in Kenya, where infertile wives are at risk of abandonment or having their husband take a second wife. "It is a major heartache. Anything to help them improve their fertility is very helpful," she said.
When she returned to the U.S., she began looking at low-tech techniques that might be feasible in undeveloped nations. She discovered NaPro Technology, which was developed with Catholic ethics in mind and builds on research that was done into women's fertility in order to make natural family planning more effective. It aims at diagnosing and solving problems based on a detailed understanding of individual body chemistry.
Although some surgical interventions can be used, it has its limits, Dr. Kummant said.
"I don't have a solution for somebody who has a total blockage of both fallopian tubes," she said. "There is a reality that everybody who wants children is not guaranteed to have a child. If you're looking at IVF, you're paying lots more money and the success rate is 30 percent."
Karl Schultz, a Catholic writer from the North Side with a background in pastoral psychology, has written a book to help infertile couples work through their difficulties by a prayerful reading of the Bible. "Bearing the Unbearable: Coping with Infertility and Other Profound Suffering," grew out of workshops on suffering and grief that he gave 15 years ago for nurses. He was surprised at how often they spoke of their own infertility as a cause of intense suffering and grief.
"They would bring these issues to the workshop because the church didn't have anything set up to help them deal with it. They were told you can't use IVF, but it was all from a moral standpoint," said Mr. Schultz, who isn't speaking at the worshop.
He believes infertile couples often break up because they can't talk about it in healthy ways. Men have a hard time talking about infertility, and their wives may conclude that they don't care because they don't talk about it, he said. Women, because they realize there is no one to blame for the problem, sometimes displace their anger about it onto other issues in the marriage, causing great friction, he said.
"Much of the couple's ability to survive infertility has to do with external things. Do they have good support from others? Do they have multiple stressors at the same time? If she's infertile at the same time that her husband is unemployed that can be very hard to survive," he said.
The Bible has many stories about infertility. The story of Rachel and Leah illustrates the great jealousy that can arise when an infertile woman's sister has children, he said. But one problem for those who turn to the Bible for comfort is that its infertility stories often end with a miracle baby. This can make couples feel that their infertility is due to a lack of faith or that God doesn't love them.
It's important to remember that the stories aren't trying to explain infertility, but to show God's power, Mr. Schultz said.
"The biblical authors knew that things did not always turn out well [for infertile couples]. They are pointing in the long term to God's plan of salvation," he said.
The seminar, from 8:30 a.m. to 2:30 p.m. Saturday at St. Paul Seminary, East Carnegie, includes breakfast, lunch and materials for a donation of $20 per person or $30 per couple. To register, call 412-456-3157.
Ann Rodgers can be reached at firstname.lastname@example.org or 412-263-1416.